Hi all, been a long time since I've been on the board. I had my blood work a few weeks ago and it read as:
TSH 1.38 (.3 - 5.0 normal)
T4 1.02 (.70-1.48 normal)
T3 3.2 (2.3-4.2 normal)

I'm feeling okay but after starting a beta blocker I feel like I need an increase in meds. I'm taking what seems like a ton of thyroid medication currently. It's 100mg of Levoxyl and 3/4 of a pill of Armour. Does that seem like a lot of medication? How do my numbers look? I'm considering uping the Armour to a full pill. Any thoughts from the more experienced members of this board?

What are most of you taking as far as thyroid medication strengths? Are there a lot of people doing the combination therapy out there?

What strength is the Armour pill? Can't tell you much about your dose without knowing that.

Your labs leave room for a small dose increase. But, do you know that beta blockers are noted for slowing metabolism, causing slower heart rate, sluggishness, fatigue, and weight gain? You may not be able to blame your thyroid dose entirely if any of these have been problems only since you started taking the beta blocker.

I'm sorry I thought that Armour only had one dosing amount so that one pill equaled 60mg or 1 Grain. I take 3/4 of 60 mg pill in addition to the 100 mg of Levoxyl.

Doctor swore that the Beta Blocker won't make you feel any of those physical responses...of course, I don't agree because I have read each of the things you mentioned. Problem is that I really need the pill due to high blood pressure and my pulse rate. Not much wiggle room. Maybe there is a beta blocker that someone can recommend with less side effects? I currently take Toprol xl.

I don't think I'll mess with a dose increase as I don't want to throw myself over into Hyper especially if it could be related to the BB.

Your Levoxyl and Armour together are an approximate equivalent of 150 mcgs of T4-only, which would be an average full replacement dose. It isn't excessive, and as I said before, you have room for an increase if you decide you need one. I'm unsure which would be better to increase, though. Just doing the rough math, it looks like your FT4 is in the high 40th percentile; FT3 is almost at 50%. Most people need these higher to feel well. Judging by your TSH, you are probably undermedicated. TSH is generally below-normal to completely suppressed when T3 is used in an optimal amount. My feeling is that you could safely increase to 60 mgs of Armour as a trial, unless you have ever had any kind of cardiac effects from T3. In that case, it would be better to try increasing the Levoxyl first.

I'm sure about those beta blocker side effects. Since my husband has been taking one, he falls asleep at the drop of a hat, can't get his heart rate above 50 when exercising, and his fingertips are like icicles in the winter. Of course, side effects don't happen to everyone, but think some doctors try to pretend they don't happen at all so as not to put ideas into their more suggestible patients' heads. (Not saying that you in particular are suggestible. It could just be your MD's way of doing business.)

Edit to add: I take 120 mgs of Armour per day, which is the rough equavalent to 150 mcgs of a T4 drug. But there isn't a lot of sense in trying to compare one person's dose to another's, because everyone's requirements can be very different.

Thank you so much for your information. You mention the 40th percentile for the T4 and 50th for T3....what are the optimal percentages that a person should reach for these areas? I think I read somewhere in the 70th percentile for T3...am I close to correct on that? When your T3 is in good range does that typically mean that your TSH is almost suppressed?

I appreciate the information on this website more than you can imagine because even though I have a good doctor I feel like a person only gets a portion of information from them regarding thyroid.

I just double-checked my math with a calculator. Your FT4 comes out to 41% of its range; your FT3 is 47%. These are low for most people, who need them at least 50% and roughly balanced (which yours are). The optimum range is between 50-75/80%, with most people falling somewhere in between. The best way is to aim for those levels while watching to see how symptoms respond. When most symptoms are alleviated, take note of where your levels are and aim to keep them there.

People who take T3 orally in an optimal amount almost always have suppressed TSH. My own TSH has never been higher than .02 in over 4 years, yet my FT4/FT3 are not excessively high, so I can't be considered overmedicated and hyperT. A doctor who prescribes T3 meds should know the effect that T3 has on TSH and should dose according to FT4/FT3 only, disregarding TSH altogether. Your "normal" TSH, along with your low-normal FT levels, is what tells me you haven't reached an optimal dose yet.

Yeah, I know exactly what you mean about doctors' view of thyroid disorders. There are a lot who don't understand unless they have it themselves. I've had to stand up for myself several times in order to get optimally treated.

One thing I'll say about high BP and heart palpatations. Low thyroid levels can cause both of those. There's no guarantee that if you'd raise your FT levels that these problems would cease, but there is some possibility of it. Just so you know.

I suggest you visit the High and Low Blood Pressure board to ask about what meds might have fewer side effects than the beta blocker.

What a wealth of knowledge you've been! Thank you! One last question for you. I've been trying to figure out the equation you have used to find out what percentile I'm in and can't get it. Can you break down how you arrived at one of those percentages for me? That way I can keep track of those numbers as my labs change? It's probably some simple math equation but I just can't come up with it!

Now that I look back at your T4/T3 results, I had assumed that they are free level results, not total. Please confirm whether the assumption is correct. The ranges are typical for the free levels, but we need to be sure since the free levels are more accurate than totals.

This is how I do the math:
Using your FT4 result and range as an example -- T4 1.02 range [.70 - 1.48]
1. Subtract the bottom of the range from the top (1.48 - .70 = .78)
2. Subtract the bottom of the range from your value (1.02 - .70 = .32)
3. Divide the result of #2 by #1 (.32 ÷ .78 = .4102) and turn the .4102 into a percentage = 41%

I just double-checked my math with a calculator. Your FT4 comes out to 41% of its range; your FT3 is 47%. These are low for most people, who need them at least 50% and roughly balanced (which yours are). The optimum range is between 50-75/80%, with most people falling somewhere in between. The best way is to aim for those levels while watching to see how symptoms respond. When most symptoms are alleviated, take note of where your levels are and aim to keep them there.

People who take T3 orally in an optimal amount almost always have suppressed TSH. My own TSH has never been higher than .02 in over 4 years, yet my FT4/FT3 are not excessively high, so I can't be considered overmedicated and hyperT. A doctor who prescribes T3 meds should know the effect that T3 has on TSH and should dose according to FT4/FT3 only, disregarding TSH altogether. Your "normal" TSH, along with your low-normal FT levels, is what tells me you haven't reached an optimal dose yet.

Yeah, I know exactly what you mean about doctors' view of thyroid disorders. There are a lot who don't understand unless they have it themselves. I've had to stand up for myself several times in order to get optimally treated.

One thing I'll say about high BP and heart palpatations. Low thyroid levels can cause both of those. There's no guarantee that if you'd raise your FT levels that these problems would cease, but there is some possibility of it. Just so you know.

I suggest you visit the High and Low Blood Pressure board to ask about what meds might have fewer side effects than the beta blocker.

Welcome to this board.

Mastiff4mee and Midwest,
I was just prescribed Propranolol, a beta blocker, and am VERY concerned about it. I am on Synthyroid and a little armour, still upping very slowly so my heart will stay ok. still tweaking! But getting there. Tachycardia occurs frequently, like 3-4 nights a week, and he wants me to take B blocker PRN. BUT beta blockers will suppress the active T3, right? SHEESH. I am not interested in crashing hypothyroid every time I have to take one. (it is a small dose, but i am very sensitive)

Do you have resolution to your problem? I don't have high BP, only tachycardia up to 114 with some exertion.